handing out sterile injection equipment or bleach bottles to injection drug users does not address the underlying problems associated with drug abuse.

The high levels of concern about potential negative effects of needle exchange and bleach distribution programs cannot be ignored, despite the paucity of evidence supporting them. Furthermore, the long-term effects of these programs on the level of illicit drug use in communities are not yet known. Communities experiencing high levels of drug use and addiction, AIDS, crime, and poverty may well resent the institution of needle exchange and bleach distribution programs, seeing them as a wholly inadequate response to the underlying problems associated with drug abuse and perceiving that they do more harm than good. The panel urges that local community members (e.g., police, church, treatment providers, pharmacists, local public health authorities) should be involved in determining whether such programs should be implemented locally and how they should be institutionalized.

The legal environment is another, very different factor impinging on needle exchange and bleach distribution programs. On the basis of its review of the legal circumstances in which these programs operate, the panel concludes:

  • Any marked increase in the supply of sterile needles to injection drug users above current levels through pharmacy sales is likely to call for new measures to ensure the safe disposal of used needles. Whereas this problem has been solved in other countries (e.g., Australia provides special containers in public places that allow for proper disposal of used syringes, as well as individual returnable containers for used syringes), it is important to design good solutions to the disposal issue in the United States now.

  • Laws that make it a criminal offense to possess injection equipment (paraphernalia laws) were designed to decrease the prevalence of injection drug abuse, but they also inhibit users from carrying their own supply of needles and thus unwittingly contribute to the sharing of contaminated ones.

  • Laws requiring a prescription for the purchase of new needles and syringes (prescription laws) constrain the availability of sterile injection equipment and thus promote the sharing of contaminated equipment.


The panel concludes that well-implemented needle exchange programs can be effective in preventing the spread of HIV and do not increase the use of illegal drugs. Hence, we recommend that:

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